Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

Zaidi, Razi; Macgregor, Alexander; Cro, Suzie; Goldberg, Andy

doi:10.1136/bmjopen-2016-011947

Cited by 12 publications

(6 citation statements)

References 23 publications

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“…Whether vessel wall embolization or in-situ inclusion of vessel wall components into the thrombus is a common phenomenon in MT remains unclear. This patient suffered from ischemic stroke soon after orthopedic surgery but as the incidence of pulmonary embolism after such operations are low ( 37 ) there may be no causality in this case but a mere coincidence.…”

Section: Discussionmentioning

confidence: 88%

Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi – A Multicenter Experience

et al. 2022

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BackgroundSeveral studies have investigated the histopathology of mechanically retrieved thrombi from stroke patients. Thrombi with unusual components constitute about 1–2% of all stroke thrombi in clinical practice. Knowledge about these rare components is limited.ObjectivesTo characterize the histopathology of unusual stroke thrombi from a real-world setting with relation to clinical presentation, patient characteristics and procedural aspects of mechanical thrombectomy.MethodsOne-thousand and eight thrombi retrieved from stroke patients with mechanical thrombectomy at three different hospitals were retrospectively reviewed for unusual histological components. Fifteen thrombi were included in the study for further histopathological analysis. Clinical data and data on procedural aspects were collected.ResultsWe identified six cases with large amounts of extracellular DNA, of which three were calcified. All six cases except one received anticoagulant therapy. We describe two types of calcifications that differ with respect to general calcification morphology, von Kossa staining pattern, macrophage immunophenotype and presence of multinucleated giant cells. Cholesterol-rich (n = 3), adipocyte-like pattern-rich (n = 2), collagen-rich (n = 2) and myxomatous (n = 1) thrombi were also identified and are discussed with regard to pathogenesis and clinical and intervention characteristics. Finally, a thrombus with parts of a vascular wall is described. Suggestions for future studies are made and clinical and technical aspects of the management for these rare but important patients are discussed.ConclusionIn our retrospective multicenter study, we characterized stroke thrombi histopathologically and found subgroups of thrombi defined by presence of rarely seen components. These defined subgroups showed relation to underlying cardiovascular disease, patient characteristics, and mechanical thrombectomy technique. Knowledge about these components may increase our understanding of stroke pathophysiology and influence interventional procedures.

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Section: Discussionmentioning

confidence: 88%

Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi – A Multicenter Experience

et al. 2022

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“…As a result, 9 studies with a total of 10 388 patients were eligible for inclusion in the quantitative analysis [6][7][8]15,16,26,53,62,64 and 28 in the narrative synthesis. [1][2][3][4][5][9][10][11]13,14,[17][18][19]23,25,29,[34][35][36]40,44,47,48,50,51,56,59,65…”

Section: Search and Selectionmentioning

confidence: 99%

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

Varga,

Váncsa,

Agócs

et al. 2023

Foot Ankle Int.

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Background: The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. Methods: We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). Results: Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. Conclusion: Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis’s survival.

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“…7,8,16 Such complications may predispose to revision, explant, or even amputation following the initial ankle replacement. 37 Current data on revision rates following TAR is mixed. A Medicare study by Tucker et al 32 reported the 9-year revision rate of TAR at 11%.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 , 16 Such complications may predispose to revision, explant, or even amputation following the initial ankle replacement. 37 …”

Section: Introductionmentioning

confidence: 99%

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

Ratnasamy,

Maloy,

Oghenesume

et al. 2023

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) surgery has increased in recent decades. The aim of this study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or explant. Methods: Using the 2010 to 2020 PearlDiver M151Ortho data set, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients via Current Procedural Terminology ( CPT) and International Classification of Disease Procedural ( ICD-P) codes. This database contains billing claims information across all payers and sites of care in the United States. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI). Annual incidence for primary TAR was normalized per 100 000 covered lives in the data set for each year of study and recorded. Annual incidence of revision TAR and explant were normalized per 100 TARs performed for each year of study. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant. For explants, the eventual intervention by 2 years was analyzed. Ten-year timing and survival to revision or explant surgery following unilateral TAR were characterized. Results: A total of 10 531 primary, 1218 revision, and 1735 explant TARs were identified. After normalization, TAR utilization increased by 284% from 2010 to 2020, annual TAR revisions rose 28%, and annual TAR explants decreased 65%. Independent predictors of revision TAR were younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase). Independent predictors of explant included younger age (OR 1.80 per decade decrease), female sex (OR 1.17), and higher ECI (OR 1.35 per 2-point increase). The 10-year implant survival rate was 91.8%, of which 73% of revisions and 83% of explants occurred in the first 3 years following index TAR. Conclusion: TAR utilization has grown substantially over the past decade, with minimal increases in the annual rate of revision surgery with respect to index procedures performed. Level of Evidence: Level III, retrospective cohort study.

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Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

Cited by 12 publications

References 23 publications

Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi – A Multicenter Experience

Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi – A Multicenter Experience

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

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